POS1486-HPR DETECTION OF ASSOCIATED FIBROMYALGIA IN PATIENTS WITH OSTEOARTHRITIS OF THE KNEE ACCORDING TO THE MULTIDIMENSIONAL HEALTH ASSESSMENT QUESTIONNAIRE/ FIBROMYALGIA ASSESSMENT SCREENING TOOLS (MDHAQ/FAST4).
Authors: Y. Ponce, O. Rillo, A. Brigante, O. Leonardi, E. Raad, M. C. Lunic
Journal: Annals of the Rheumatic Diseases (2022)

Background Osteoarthritis is the most prevalent joint pathology. knee Osteoarthritis is one of the most frequent locations and has the greatest impact on the health of patients. It can be associated up to 11% with depression and 23% with neuropathic pain. It has also been reported that it can coincide with fibromyalgia (FM) between 6% and 22.83%. This difference may be attributed to some factors, e.g., sample size and/or socioeconomic status. Therefore, the clinical interpretation of symptoms in knee osteoarthritis may be overestimated by the presence of FM. Pincus T. et al. used the FAST4 to identify the coexistence of FM in patients with various rheumatic pathologies. The FAST4 consists of using the MDHAQ (symptom checklist, painful joint count, fatigue and pain). A FAST4 score ≥ 3 allows the association of FM to be considered. The authors demonstrated good concordance with the 2011 FM criteria according to the ACR (with a sensitivity of 70.4% and a specificity of 97.1%) Objectives To detect the presence of associated FM in patients with early and established knee osteoarthritis employing the MDHAQ/FAST4 Methods Patients ≥18 years, of both sexes, from our community with early and established knee osteoarthritis (Luyten, FP 2018 and Altman, R 1986 Classification Criteria respectively). All answered the MDHAQ/FAST3-F questionnaire, in addition to the Patient Health Questionnaire (PHQ9) and the Neuropathic Pain 4 Questions (DN4). Depression was considered respectively with a score ≥3 of the PHQ9 and neuropathic pain with 4 points of the DN4 Results 100 patients (96 with a diagnosis of early knee osteoarthritis and 4 with established knee osteoarthritis [Luyten - ACR]) with a median age of 58 (RIC 16) and female sex were included 72%.We observed associated FM (FAST4-F) in 31% of patients (27 with early knee osteoarthritis and 4 with established knee osteoarthritis). Median VAS pain, patient and physician global assessment of the disease was higher in patients with FM (p&lt;0.0001). Disease activity by RAPID 3 was low in 4%, moderate in 38% and high in 58% of patients. The cohort had a median pain score of 60 (RIC 60) with absence of neuropathic pain (DN4) in 90% of patients. Depression (PHQ9) was observed in 29% of cases.OA evolution time in months in patients with FM 48 (RIC 12) vs. 36 (RIC 24) without FM (p&lt; 0.0001).Binary logistic regression was performed. In the bivariate analysis, it was observed that the presence of early OA by Luyten’s criteria (p=0.002), the presence of depression by PHQ9 (p=0.001), patients of white ethnicity (p=0.03), sobrepeso (p=0.002), low RAPID 3 disease activity (p=0.001), kellgren and lawrence grades II and III (p=0.001), were significant in the bivariate model, although none were statistically significant in the multivariate model Conclusion The evaluation of knee osteoarthritis can be complicated in those patients who coexist with FM. In our study 31% met criteria for this entity according to MDHAQ/FAST4. We consider this questionnaire to be single and practical for detecting associated FM. The results obtained give hierarchy to the use of PROMs (Patient Reported Outcomes Measures) that can recognize clues of associated diseases such as FM and/or depression. And thus be able to establish a timely and appropriate treatment when these pathologies are overlapping, in order to change the patient’s prognosis and improve their quality of life References [1]Pincus T, Schmukler J, Castrejon I. Patient questionnaires in osteoarthritis: what patients teach doctors about their osteoarthritis on a multidimensional health assessment questionnaire (MDHAQ) in clinical trials and clinical care. Clin Exp Rheumatol 2019; 37(Suppl. 120): S100-S111. [2]Gibson K, Castrejon I, Descallar J, et al. Fibromyalgia Assessment Screening Tool: Clues to Fibromyalgia on a Multidimensional Health Assessment Questionnaire for Routine Care. J Rheumatol. 2020;47(5):761-69 Acknowledgements Unidad de investigación de la Sociedad Argentina de Reumatología(UNISAR) Disclosure of Interests None declared